Test Appointment Request Form Old | University Testing Center

Test Appointment Request

First Name

Last Name

9 Digit UCCS Student ID Number

Have you received permission from your instructor to schedule a make-up exam at the University Testing Center?

Yes

Is the exam your requesting a Canvas or online exam?

If Yes, your test appointment request will be denied. The Testing Center proctors paper-based exams ONLY. Please contact your instructor for alternate proctoring options.

Yes

Date: Please provide your top three requested dates in order of preference. The appointment date/time will be approved/declined by the University Testing Center staff.

Course Information

(e.g., PSY 1000 Section 006).

Course Name and Section Number

Instructor Name (First and Last)

(e.g., Quiz 2, Midterm 1, Final Exam).

Exam Name

Are you requesting to take the Reasoning Skills Test (RST)?

Yes

Proctoring Charge

The cost to the student is $30.00/exam. This is required at the appointment date/time. If you are requesting an exemption to the proctoring charge, please indicate the reason from the list below:

If you are a student in one of the scenarios above, please bring proof of the conflict for review from the Testing Center staff to your appointment. Examples of proof include syllabi with test dates, copies of orders, summons, or athletics schedule.

Other Requests or Notes to University Testing Center